Abstract | BACKGROUND:
Crohn's disease (CD) shows a chronic relapsing course but no marker of relapse is currently available. However, fecal alpha 1-antitrypsin (alpha 1-AT) clearance (alpha 1-ATCl) is an indicator of protein loss and increases during active inflammation. We assessed the usefulness of fecal alpha 1-ATCl in predicting clinical relapse in patients with inactive ileal CD. DESIGN: In a prospective longitudinal study, 26 patients with inactive ileal CD ( Crohn's disease activity index (CDAI) < 150) (18 males, mean age 43 +/- 10, range 23-58) were enrolled. Fecal alpha 1-ATCl and concentration, daily stool weight and serum alpha 1-AT were measured at baseline (visit 1), after 1 week (visit 2) and 3 weeks (visit 3) in 24/26 patients (two drop-outs) (short-term study). In six of these 26 patients, fecal alpha 1-ATCl was also measured every 3 months for 1 year (long-term study). All patients were clinically assessed every 3 months for 1 year and every 6 months for 2 years. Ten healthy volunteers were tested as controls. METHODS: Serum and fecal alpha 1-AT concentration was quantified by radial immunodiffusion. RESULTS: The median fecal alpha 1-ATCl value at baseline was higher in inactive patients undergoing clinical relapse (CDAI > 200) in the next 6 months than in those remaining in remission at 6 months (P = 0.03). Fecal alpha 1-ATCl showed a 75% sensitivity, 85% specificity, 50% positive predictive value and 94% negative predictive value in predicting CD relapse in the next 6 months. In the long-term follow-up, fecal alpha 1-ATCl values increased at 12 months compared with both baseline and 6 month values (P = 0.005; P = 0.009). Fecal alpha 1-ATCl was higher in patients with raised C-reactive protein (P = 0.039). CONCLUSIONS: Results from our study suggest that fecal alpha 1-ATCl is an indicator of clinical relapse in patients with CD of the distal ileum under regular surveillance.
|
Authors | Livia Biancone, Massimo Fantini, Claudio Tosti, Rosamaria Bozzi, Piero Vavassori, Francesco Pallone |
Journal | European journal of gastroenterology & hepatology
(Eur J Gastroenterol Hepatol)
Vol. 15
Issue 3
Pg. 261-6
(Mar 2003)
ISSN: 0954-691X [Print] England |
PMID | 12610321
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
|
Chemical References |
- Biomarkers
- alpha 1-Antitrypsin
- C-Reactive Protein
|
Topics |
- Adult
- Biomarkers
(analysis)
- C-Reactive Protein
(metabolism)
- Crohn Disease
(diagnosis, metabolism)
- Feces
(chemistry)
- Female
- Humans
- Male
- Middle Aged
- Predictive Value of Tests
- Prospective Studies
- Recurrence
- Sensitivity and Specificity
- alpha 1-Antitrypsin
(analysis)
|